| 1. |
- Henricsson, Marianne
(författare)
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Hyperglycaemia and diabetic eye complications - a clinical and epidemiological study
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To study the relationship between hyperglycaemia and the onset/progression of retinopathy, blindness/moderate visual impairment or death, as well as the impact of improved glycaemic control on retinopathy in patients with non-insulin-dependent diabetes mellitus (NIDDM). Methods: Between January 1990 and October 1995 a total of 3,220 diabetic patients were enrolled in a programme for control and screening for retinopathy. Of them 483 (15%) were below 30 years of age, and 2,737 (85%) 30 years or more at diagnosis and were considered representative of patients with insulin-dependent diabetes mellitus (IDDM) and NIDDM, respectively. Retinopathy was graded on fundus photographs using the Wisconsin scale. The time points for detection of blindness (visual acuity 0.1 or less)/ moderate visual impairment (visual acuity 0.2-0.4), progression of retinopathy or death were recorded. The average HbA1c for each patient was used to estimate long-term glycaemic control. Results: Prevalence, development and progression of retinopathy were significantly associated with poor glycaemic control in all diabetic patients. The presence of retinopathy at baseline predicted progression in the NIDDM group. A non-linear relationship was found in NIDDM between mean HbA1c and progression of retinopathy 3 levels or more with a threshold value of about 8.0 %. Patients who changed treatment from oral agents to insulin therapy had an increased risk for progression of retinopathy, which most likely was due to rapid lowering of blood glucose. Poor glycaemic control, severe retinopathy, and blindness were predictors of mortality. Conclusions: Poor glycaemic control and intensified treatment with insulin are risk factors for progression of retinopathy in patients with NIDDM.
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| 2. |
- Henricsson, Marianne, et al.
(författare)
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Incidence of blindness and visual impairment in diabetic patients participating in an ophthalmological control and screening programme
- 1996
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Ingår i: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907. ; 74:6, s. 533-538
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Tidskriftsartikel (refereegranskat)abstract
- We studied the incidence of blindness and visual impairment in patients who were enrolled in a photographic control- and screening program for diabetic retinopathy. The study cohort consisted of 2133 patients examined between January 1990 and December 1992 and followed until October 1st 1995. The occurrence of blindness (visual acuity ≤ 0.1) and moderate visual impairment (visual acuity 0.2-0.4) was assessed. The Wisconsin scale was used to grade retinopathy. The mean HbA(1c) value for the last 8 years was used to represent long-term glycaemic control. Average follow-up time was 2.9 years. Seven patients were blind and 24 had visual impairment caused by retinopathy at the entry of the study. Six patients went blind due to retinopathy during the study period, corresponding to an incidence of 1.0 per 1000 person-years (95% confidence interval 0.4-2.1), and 28 became visually impaired, corresponding to an incidence of 4.6 per 1000 person-years (95% confidence interval 3.0-6.6). Multivariate analysis showed a statistically significant association between blindness/visual impairment and old age, long duration of diabetes, and poor glycaemic control. HbA(1c) values in the highest quartile, i.e ≤ 8.5%, were associated with a 65% increase in risk of blindness/visual impairment (95% confidence interval 14-130%). Retinopathy was the major cause of blindness and visual impairment in patients with diabetes. The study revealed a low incidence of blindness, which is in line with recent reports. Control of hyperglycaemia may be of value for the prevention of visual loss.
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| 3. |
- Henricsson, Marianne, et al.
(författare)
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Prevalence of diabetic retinopathy in relation to age at onset of the diabetes, treatment, duration and glycemic control
- 1996
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Ingår i: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907. ; 74:6, s. 523-527
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Tidskriftsartikel (refereegranskat)abstract
- To study the frequency of diabetic retinopathy in relation to age at diagnosis, treatment, duration of diabetes and glycemic control as measured by means of HbA(1c) levels, we performed a cross-sectional, register-based study in the Helsingborg area of southern Sweden, comprising 2232 diabetic patients. Of the known diabetic population < 75 years old, approximately 70% were estimated to be included. We graded retinopathy according to the alternative classification of the Wisconsin study. With an age at diagnosis < 30 years (19% of patients) the prevalence of retinopathy was 64%, whereas with an age at diagnosis ≤ 30 years the prevalence of retinopathy was 57% in insulin-treated, and 26% in non-insulin treated patients. Levels of glycated hemoglobin and duration of diabetes were associated with retinopathy in the group with younger onset. In the older-onset group, there was a relationship between retinopathy and duration of diabetes and insulin treatment; glycated hemoglobin had a relationship which was of borderline significance with any retinopathy, but clearly significant with the pooled group: severe non-proliferative, proliferative retinopathy and/or macular edema. Hyperglycemia and duration of diabetes were thus associated with retinopathy in both younger- and older-onset diabetes, but hyperglycemia less so in the older-onset group.
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| 4. |
- Henricsson, Marianne, et al.
(författare)
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Progression of retinopathy after improved metabolic control in type 2 diabetic patients. Relation to IGF-1 and hemostatic variables
- 1999
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Ingår i: Diabetes Care. - 1935-5548. ; 22:12, s. 1944-1949
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the impact of improved glycemic control on the development and progression of retinopathy after the institution of insulin therapy in patients with type 2 diabetes and to assess the relation to IGF-1 and hemostatic variables. RESEARCH DESIGN AND METHODS: In a prospective observational study, 45 type 2 diabetic patients were examined at baseline and 1, 3, 6, 12, and 24 months after change to insulin therapy. Retinopathy was graded on fundus photographs using the Wisconsin scale; HbA1c, IGF-1, and hemostatic variables were measured. RESULTS: During the observation period of 2 years, 23 patients progressed in the retinopathy scale; 8 progressed > or = 3 levels. After 2 years of insulin treatment, HbA1c and IGF-1 were significantly lower than at baseline, whereas the hemostatic variables had not changed significantly. Progression of retinopathy > or = 3 levels was related to the degree of HbA1c reduction, the duration of diabetes, a higher prothrombin fragment 1 + 2 levels (F1 + 2), but not to other hemostatic variables or IGF-1. The relative risk for progression > or = 3 levels was 2.6 when HbA1c had been reduced > or = 3 percent units (95% CI 1.1-6.1). CONCLUSIONS: The magnitude of improvement of HbA1c by the institution of insulin treatment over a 2-year period may be associated with progression of retinopathy in patients with type 2 diabetes.
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| 5. |
- Henricsson, Marianne, et al.
(författare)
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Progression of retinopathy in insulin-treated type 2 diabetic patients.
- 2002
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 25:2, s. 381-385
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE—To study the progression of retinopathy 3 years after initiation of insulin therapy. RESEARCH DESIGN AND METHODS—In a prospective, observational case-control study, 42 type 2 diabetic patients were examined at baseline and 1, 3, 6, 12, 24, and 36 months after change to insulin therapy. Retinopathy was graded based on fundus photographs using the Wisconsin scale; HbA1c and IGF-1 were measured. RESULTS—During the observation period of 3 years, 26 patients progressed in the retinopathy scale; 11 patients progressed at least three levels. After 3 years of insulin therapy, HbA1c and IGF-1 were significantly lower than at baseline. Progression of retinopathy greater than or equal to three levels was related to high IGF-1 levels. CONCLUSIONS—A relationship was found between high IGF-1 levels at 3 years and progression of retinopathy in type 2 diabetic patients.
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| 6. |
- Henricsson, Marianne, et al.
(författare)
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Progression of retinopathy is related to glycaemic control even in patients with mild diabetes mellitus
- 1996
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Ingår i: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907. ; 74:6, s. 528-532
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Tidskriftsartikel (refereegranskat)abstract
- To study the progression of retinopathy in patients with mild diabetes mellitus, we examined, in a cohort study, 347 patients treated with diet alone at baseline. The patients participated in an ophthalmological screening and control programme, and diet-treated patients who were examined between January 1990 and July 1992 were included in the study and followed until October 1995. Mean follow-up time was 3.4 ± 1.1 years. The alternative classification of the Wisconsin study was used to classify retinopathy, and the mean HbA(1c) values for the study period, to estimate the level of glycaemic control. At baseline, 314 of the patients (90.5%) had no retinopathy, and 33 (9.5%) had mild non-proliferative diabetic retinopathy. In 296 patients there was no retinopathy progression, in 27 patients there was progression by 1 level in the retinopathy scale, and in 24 patients by 2 levels or more. In 2 patients there was progression to proliferative diabetic retinopathy. The mean HbA(1c) (%) was 6.5 ± 1.3. Higher HbA(1c) correlated to increased progression (r = 0.16; p = 0.005), and in a multivariate analysis, HbA(1c) remained associated with a progression of retinopathy by 2 levels or more, with a relative risk of 1.4 per percent increase in HbA(1c) (95% CI 1.1-2.0; p = 0.02). Furthermore, the presence of any retinopathy at baseline was associated with progression with a relative risk of 1.7 (95% confidence interval 1.1-2.8; p = 0.02). These data indicate that even slightly elevated levels of HbA(1c) might be associated with a risk of retinopathy progression.
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| 7. |
- Henricsson, Marianne, et al.
(författare)
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The incidence of retinopathy 10 years after diagnosis in young adult people with diabetes: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS).
- 2003
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 26:2, s. 349-354
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE—To estimate the prevalence and severity of diabetic retinopathy (DR) 10 years after diagnosis in a nationwide population-based cohort study of young adult diabetic patients in Sweden. RESEARCH DESIGN AND METHODS—The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases of diabetes aged 15–34 years in Sweden. In 1987–1988, 806 cases were reported, and 627 (78%) of them were followed up with regard to retinopathy 8–10 years later. The assessment was based on retinal photographs in most cases (86%). RESULTS—Ten years after diagnosis, retinopathy was found in 247 patients (39%). The retinopathy was mild in 206 (33%), whereas 30 (4.8%) patients had moderate nonproliferative DR (NPDR) and 11 (1.8%) had proliferative DR (PDR). Patients with retinopathy had worse glycemic control during the years than patients without (HbA1c 8.1 ± 1.5% and 6.8 ± 1.2%, respectively; P < 0.001). In a Cox regression analysis, time to retinopathy was related to high HbA1c (P < 0.001) and high BMI (P = 0.001). Patients with type 2 diabetes had an increased prevalence of severe retinopathy (NPDR or PDR) compared with those with type 1 diabetes (14 of 93 [15%] versus no or mild 24 of 471 [5%], respectively; P < 0.001). CONCLUSIONS—Despite modern diabetes management, 39% of young adult diabetic patients developed retinopathy within the first 10 years of the disease. Nevertheless, compared with the prevalence of retinopathy (63%), after a similar duration of diabetes before the Diabetes Control and Complications Trial, this prevalence was clearly lower. Current treatment aimed to achieve strict glycemic control has reduced the risk for developing retinopathy.
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| 8. |
- Svensson, Maria, et al.
(författare)
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Signs of nephropathy may occur early in young adults with diabetes despite modern diabetes management : Results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS)
- 2003
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 26:10, s. 2903-2909
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE - To estimate the occurrence of early-onset renal involvement in a nationwide population-based cohort of young adults with diabetes in Sweden and relate the findings to glycemic control, type of diabetes, sex, smoking, and blood pressure. RESEARCH DESIGN AND METHODS - The Diabetes Incidence Study in Sweden aims to register all incident cases of diabetes in the age-group 15-34 years. In 1987-1988, 806 patients were reported and invited to participate in a follow-up study focusing on microvascular complications. Of them, 469 subjects participated. The assessment was based on questionnaires (n = 469), blood samples (n = 424), urine samples (n = 251) and, when appropriate, medical records (n = 186). RESULTS - During the follow-up time, median 9 years (range 6-12), 31 of 469 patients (6.6%) with incipient or overt diabetic nephropathy (i.e., micro- or macroalbuminuria) were found, 24 of 426 (5.6%) in type 1 and 7 of 43 (16%) in type 2 diabetic subjects (P = 0.016). Additionally, 24 of 31 patients (77%) had microalbuminuria and 7 (23%) had macroalbuminuria, which mainly occurred in patients with type 2 diabetes. In a Cox regression analysis, high mean HbA1c during the follow-up period and high blood pressure at follow-up increased the risk of developing signs of nephropathy (P = 0.020 and P = 0.003, respectively). Compared with patients with type 1 diabetes, those with type 2 diabetes tended to have an increased risk of renal involvement (P = 0.054) when adjusting for sex, tobacco use, glycemic control, and blood pressure. CONCLUSIONS - Despite modern treatment and self-monitoring of blood glucose, young adult patients with diabetes may still develop renal involvement during the first 10 years of diabetes duration. Inadequate HbA 1c high blood pressure, and type 2 diabetes appear to be risk markers for early occurrence of diabetic nephropathy.
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| 9. |
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| 10. |
- Torffvit, Ole, et al.
(författare)
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Early changes in glomerular size selectivity in young adults with type 1 diabetes and retinopathy. Results from the Diabetes Incidence Study in Sweden.
- 2007
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Ingår i: Journal of Diabetes and its Complications. - : Elsevier BV. - 1873-460X .- 1056-8727. ; 21:4, s. 246-251
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the relationship between early-onset retinopathy and urinary markers of renal dysfunction. Research Design and Methods: The Diabetes Incidence Study in Sweden (DISS) aims to register all new cases of diabetes in young adults (15-34 years). In 1987-1988, 806 patients were reported and later invited to participate in a follow-up study focusing on microvascular complications after similar to 10 years of diabetes. In the present study, 149 patients with type I diabetes, completed eye examination, and urine sampling were included. Results: The patients with retinopathy (n=58, 39%) had higher HbA(1c), (P<.001) and urinary IgG2/creatinine (P<.05) and IgG2/IgG4 ratios (P<.05). Patients with maculopathy had the highest levels. No significant differences in urinary albumin/creatinine, glycosaminoglycans (GAGs)/creatinine, Tamm-Horsfall protein (THP)/creatinine, and IgG4/creatinine ratios were found. Women had higher urinary albumin/ creatinine (P<.01) and urinary IgG2/creatinine ratios (P<.01) than men. Conclusions: Young adults with type I diabetes and early-onset retinopathy had higher IgG2/creatinine and IgG2/IgG4 ratios than patients without retinopathy indicating that retinopathy is associated with a change in glomerular size selectivity. This was found in association with normal urinary albumin and THP excretion and may be suspected to reflect early general vascular changes. (C) 2007 Elsevier Inc. All rights reserved.
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